- Medical debt in collections persisted on cancer patients’ credit records for 6+ years.
- Cancer survivors’ medical debt increased by only $15.45 compared to control groups overall.
- Patients with colorectal or bladder cancer had greater amounts of total debt in collections.
The adverse impact of even modest amounts of medical debt in collections can linger for years after a cancer diagnosis, posing a long-term threat of lawsuits and potential punitive actions, a study of 74,000 patients with cancer showed.
Medical debt in collections remained on patients’ credit records for 6 years or longer after cancer diagnosis. The average medical debt for cancer survivors increased by only $15.45 over the study period versus a control group. Other debt metrics (total debt, debt in collections, and bankruptcies) did not change significantly. Total debt (medical and nonmedical) in collections increased for patients with colorectal or bladder cancer, reported Benjamin James, MD, of Beth Israel Deaconess Medical Center in Boston, and co-authors in JAMA Oncology.
“When you look at the numbers, superficially, you might argue that the amount of debt in collections isn’t that high,” James told MedPage Today. “The thing you have to keep in mind is it went to collections. For some people $300 might not be a big deal, but $300 for somebody else may be a bill they can’t pay. For people who are studying this, we care less about the dollar amount than we do about the overall impact of money going to collections, impacting their long-term ability to do things, as a result of this financial toxicity.”
“This impact is really substantial, and the fact that it goes on for this many years after an initial diagnosis, I don’t think has been shown before. We may think of medical debt in collections as something you deal with and then move on, even if it does cause toxicity. But this study really showed that while we don’t see a massive amount of debt that these people are experiencing, it lingers for many years.”
The study was conducted in Massachusetts where 98% of patients have insurance, “so it’s going to be drastically worse [in states with more uninsured residents],” he added.
Lingering Effects
The lingering nature of medical debt is the key finding of the study, agreed Fumiko Chino, MD, of the University of Texas MD Anderson Cancer Center in Houston.
“I was surprised that the amount of medical debt in collections was relatively small,” said Chino, who was co-editor of an editorial supplement about financial toxicity published earlier this year in JCO Oncology Practice. “This study also found that total debt, credit score, and bankruptcy did not increase, which is profoundly encouraging. This does contradict some prior research (including my own) which found that, for example, young people with cancer reported their credit score went down even 8 years after their diagnosis.”
“It’s possible that these findings are due to the unique investments that Massachusetts has made in their residents and citizens. The state has been far in advance of other states in terms of trying to promote policies that increase insurance access and quality, and fight poverty. For example, we know that the Affordable Care Act (Obamacare) was directly modeled after the 2006 Massachusetts health reform law.”
James and colleagues undertook a retrospective matched-cohort study to examine changes in adverse financial outcomes for patients with cancer over a 10-year period (2010-2019). Using data from the Massachusetts Cancer Registry they identified all residents with a first diagnosis of nine types of cancer, excluding patients with more than one diagnosis. Financial information was obtained from a national credit bureau.
Investigators examined five financial outcomes: total debt, total debt in collections, medical debt in collections, credit scores, and bankruptcy rates. Data analysis focused on matching 74,146-person cohorts of patients with a cancer diagnosis and those without.
The cohorts had a mean age of 57.2, median income of $49,000, and women accounted for 81.2% of the study population. Almost 60% of the individuals had education beyond high school, 55.5% were married, and 64.8% were homeowners. The most common type of cancer was breast (38.6%), followed by lung (18.6%) and colorectal (14.0%).
Changes in Debt Over Time
Following cancer diagnosis, total debt increased by 8.1% to $21,606 among patients with a cancer diagnosis and 8.4% ($21,573) in the control group. Prior to cancer diagnosis, total debt in collections had declined in both groups. After cancer diagnosis, total debt in collections decreased by 19.2% (to $216.00) in the study group and by 44.6% ($160.00) in the control group.
Two years before diagnosis, 2.05% of the study group and 2.12% of the control group had any medical debt in collections. Following diagnosis, medical debt in collections increased by 123.2% (to $37.25) in the study group versus 42.6% ($30.97) in the control cohort. Bankruptcies declined and credit scores increased in both groups.
Matched difference-in-differences analysis showed that medical debt in collections increased up to $15.45. An analysis limited to cancer patients with any medical debt in collections after diagnosis showed that medical debt in collections increased by $160.01 at 6 years. Total debt, total debt in collections, credit scores, and number of bankruptcies did not change after cancer diagnosis.
A subgroup analysis showed that mean total debt in collections did increase among patients with colorectal cancer ($155.55) after 6 years and those with bladder cancer ($375.77) after 5.5 years as compared with the control group. Mean medical debt in collections increased postdiagnosis for patients with breast cancer ($11.02, 4 years), cervical cancer ($33.91, 1 year), colorectal cancer ($38.99, 6 years), lung cancer ($26.68, 5.5 years), and uterine cancer ($9.77, 1 year) versus controls but not for patients with other types of cancer.
Policy change is needed to address the lasting impact of medical debt, said James.
“I think the assumption is that if somebody has insurance, they are covered, and that’s just false,” he said. “Things can and should be done, for example remove medical debt from [credit reports] because those things ultimately impact a person’s ability to get a mortgage, even get a job.”
